The late report

Reenie and I left about 8PM tonight because we need to be back at Stanford by about 7AM.  Julie, who has been the night shift nurse all three nights, says the 8AM is fiction and that is the earliest they may call Mary.  More likely, some accident victim will push her back and the work will be done sometime during the morning. 

Mary was feeling a whole bunch better on MSContin this afternoon/evening.  She was awake, aware and although at time she had her eyes closed, she was listening and reacting to the conversation.  The nurses are still giving her fentanyl boosters for breakthrough pain although the doctors want to switch her to liquid morphine sulphate (aka Roxinol).  The issue is establishing the baseline need for MSContin so the nursing staff is working to make sure they get a clear understanding of Mary's pain levels by administering the fentanyl boosters over the MSContin baseline.  Bless those nurses!  And, bless those Pain Unit doctors who figured out that the Oncology pain regimen that Mary has been on since Feb 19 was the best thing for her after 36 hours of jerking her around!  Wow, impressive!

Mary continues to be severely bloated.  Reenie and I both think it looks like 8 months pregnant right now, up from 6 months yesterday.  The morning procedure may, if appropriate, drain some or a bunch of the fluid. Putting Mary back on Dr. Visser's diuretics may also help, although they are slow acting. Why is she bloating? They have an IV dripping saline into her, she is drinking tea and water and she is not urinating to match. Simple physics, the gozinta is bigger than the gozouta, hence, bloated abdomen. Her extremities are not showing the bloating which makes it different than the SIADH in May and the bloating that presented last summer. 

Where are we? We had a nice long conversation with the Fellow, Alex Ungewickell, who laid out all the likely scenarios.  We were very pleased that he had taken the time to read Mary's entire history back to her first contact with Dr. Banerjee in April of 2009.  Dr U was quoting specific issues we have encountered this past year. Great job!  It was very impressive.  Basically, we don't know what this could be yet.  Further testing and perhaps the paracentesis will tell us what is going on. We are still on 1) Inflammation, 2) Mechanical Blockage and 3) Return of cancer. 

Saturday's CT Scan is inconclusive for the simple fact that the weekend team is not used to looking at images of a liver trisegmentectomy after the fact.  Dr. U was very forthright in saying, "I cannot read the images, I have never seen a post-liver trisegmentectomy."  He has called in the "A Team" to figure out what the images are telling them. That will happen tomorrow.

On Tuesday, the pain unit doctors are proposing a procedure that would interrupt the nerve signals.  We'll discuss the pro's and con's after the ultrasound/paracentesis event in the morning.  The pain unit procedure would basically block any pain signals from the area that is now causing Mary undue pain and discomfort.

Reenie and I were feeling much better tonight as Mary was much more comfortable on the MSContin with Fentanyl boosters.  We shall see what morning brings.